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Why Pumping Iron Is Great For Brain Cells

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In my last post I told you that I would reveal the one thing you can do to have a significant, positive and lasting effect on your brain health as you get older. See if you can spot it in the following list:

a) Learn to dance Gangnam style
b) Join a choir
c) Catch a wave
d) Pump some iron

Ok, that was a trick question. All of these answers are somewhat correct, but I was looking for the “most” correct answer (flashbacks to undergrad, anyone?): Pump some iron.

I realize I sound like a broken record – I’ve already written about how aerobic exercise can promote healthy aging here and here, and I’ve even already written about resistance training, or lifting weights, here.

So why am I at it again? Because it’s important!

I’m fresh out of the 2012 Aging and Society Conference, where researchers came together to discuss what works and what doesn’t when it comes to healthy aging. It turns out everyone pretty much agrees that exercise is hands down the most effective intervention to keep your brain cells happy into old(er) age. All sorts of different types of exercise, ranging from simply walking to attending resistance training classes, are associated with different types of improvements in cognition, memory, and even brain size.

Of course, there are different levels of effort involved with different types of exercise, or even when talking about a single form of exercise. When my friend Jess asks me to go for a walk, she means a power walk: it usually involves going up hills, sweating like a pig (even though pigs, ironically, don’t sweat much), and barely having enough breath for girl talk (though somehow we always seem to find it). When my friend Al and I go for a walk, what he means is a “mosey”: we stop to look at the view, pet the dog, chit chat with strangers, and have more than enough breath for lengthy discussions about life, work, and the possibility of alien lifeforms. When it comes to brain health, whether you’re walking or pumping iron, a little sweating and effort can go a long way. For example, resistance training has been proven to be most effective when the load, or how much weight you are working with, increases over time. So kick the intensity up a notch: there will still be plenty of time for chit chat around a post-exercise, antioxidant-rich mug of matcha (my new obsession – stay tuned).

Now that the obvious has been (re)stated, I want to take this opportunity to discuss the idea that perhaps lifestyle interventions such as exercise could be prescribed by your doctor. We know that exercise can improve cognition in aging but also conditions like depression. Should physicians prescribe lifestyle changes? Or are diet, exercise, and other lifestyle activities choices we should make ourselves? How would you feel if your doctor prescribed you exercise instead of pills? Would you be more motivated to exercise if the prescription came from your doctor instead of from your friendly Internet science blogger? Your thoughts in the comments!

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Dr. Julie Robillard is a neuroscientist, neuroethicist and science writer. You can find her blog at scientificchick.com.

Should You Get A Mammogram?

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A recent mammogram study in the New England Journal of Medicine was so controversial that the authors (Drs. Welch and Bleyer) decided to make a YouTube video to defend and explain their conclusions. Now that’s a first, isn’t it? Well kudos to the study authors for their creative approach to getting ahead of a controversy. However, their video (created for the “general public”) is still a bit too technical in my opinion. I’d like to take a crack at distilling it further.

A question on most women’s minds (as they turn 40 and beyond) is whether or not they should get a screening mammogram (x-ray of the breasts). If you have found a lump in your breast or you have a family history of breast cancer the answer is yes. No need to read any further. However, for the majority of us lumpless, family-history-free women, a screening mammogram is far more likely to expose us to unnecessary follow up testing than it is to catch a tumor early.  Dr. Welch explains that screening mammograms aren’t very good at identifying aggressive breast cancer early enough to make a difference in whether one lives or dies anyway. That’s very disappointing news.

Dr. Welch goes on to explain that most of the gains we’ve made in breast cancer survival have been because of improved breast cancer treatments, not because of early detection with mammograms. He estimates that every year in the U.S. 1.3 million women are “over-diagnosed” with breast cancer because of screening mammograms, subjecting women to unnecessary biopsies, surgical procedures, and further follow up studies. In the video, Dr. Welch doesn’t explain exactly what these “over diagnosed” cancers end up being exactly (Cysts? Benign calcifications? Early non-aggressive cancers that the immune system kills on its own?) But suffice it to say that they don’t contribute to the cancer death rates.

So, given the fact that you are more likely to suffer through a false alarm than to discover a cancer early (and even if you do find it early, if it’s the “bad” kind you may not survive) are you willing to undergo a screening mammogram? That’s a personal question that we each have to answer for ourselves. As time goes on, however, I suspect that the answer will be made for us since health insurance companies (whether public or private) will begin to balk at paying for tests that do more harm than good overall. I think this issue is really at the heart of the controversy (the perception of rolling back a health benefit that women currently “enjoy”). Eventually screening mammograms may become an out-of-pocket expense for women who simply prefer the peace of mind that a normal test can give – even at the risk of going through a false alarm.

That being said, it sure would be great if we could find a screening test that identifies breast cancer early – especially the aggressive kind. Perhaps a blood test will do the trick one day? At least it is comforting to know that we have made great strides on the treatment side, so that fewer women than ever before die of breast cancer. More research is needed on both the screening and treatment sides of course.

As for me, I do regular breast self exams – though because I have no family history of breast cancer I’ve opted out of screening mammograms because I feel the cost/benefit ratio is not in my favor. I certainly hope that a better screening test is developed before I face a potential diagnosis. I respect that other women will disagree with me – and I think they have the right to be screened with the only option we currently have: the mammogram. I’m not sure how long it will continue to be covered by insurance, but at a price point of about $100, most of us could still afford to pay for it out-of-pocket if desired.

The bottom line of this controversial research study is that screening mammograms don’t actually catch death-causing breast cancers early enough to alter their course. Even though it makes intuitive sense to be screened, long term observations confirm that overall, mammograms do more harm than good. So now we wait for a better test – while some of us continue with the old one (as the National Cancer Institute recommends), and others (like me) don’t bother.

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Thanks to ePatient Dave and Susannah Fox who brought the issue to my attention on Facebook. Isn’t social media grand?

Can Brain Games Make You Smarter?

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Can we “train” our brains to be brighter, sharper, faster?

A while back I wrote a post about a big study looking at “brain training”. The researchers wanted to know whether training programs that look like video games (like Brain Age andLumosity) could significantly improve brain performance on various tests. The results, in a nutshell, showed that while participants improved on the tasks they trained on (e.g., if the game involved ranking balls from smallest to biggest, the participants got *really* good at ranking balls from smallest to biggest), the improvement didn’t carry over to general brain function.Turns out ranking ball sizes doesn’t help you remember where you left your keys this morning.

Two years later, what’s the word?

I’m going to shift a little from how I normally do things (review a single article) and tell you about findings I learned about at the recent Aging and Society conference. At the conference, several researchers talked about brain training in the context of aging. We know that as we get older our cognitive abilities decline – we forget names and words, misplace our shopping lists, and process information a little bit more slowly. Wouldn’t it be fantastic if we could just spend ten minutes a day playing games on our iPad and successfully counter this decline? Of course it would be fantastic. Not just for us, but also for the companies who are trying very hard to convince us to buy their products to improve our cognition.

The problem is that skills are specific. If you want to become a fabulous jazz pianist, you have to play the piano (preferably jazz songs, too). If you want to become a star ballet dancer, you have to practice ballet. If you want to become a better mountain biker, you have to mountain bike – road biking will improve your leg strength and fitness, but ultimately it won’t make you a better mountain biker. So why should things be any different for brain skills?

As it turns out, they aren’t. Two years later, nearly all the research conducted in the field of brain training is turning up the same results: people only get better at the tasks they trained on – the improvement doesn’t cross over to more general skills, different skills, or everyday life. In one study, a researcher compared a commercially available brain training program with what she called an “active control” – a group that simply played regular video games like Tetris. She found that the group who spent time on the commercially available brain training program actually saw some aspects of their cognition decline compared with the control group. Bummer.

Now don’t throw out your Brain Age game yet – everyone at the conference agreed that engaging your brain in training programs is better than not doing anything. And most of the researchers felt that while the programs don’t work now, it’s not to say they’ll never work. We are increasingly more knowledgeable about how the brain works, what happens when we get old, and what different training tasks do. So it’s quite possible that sometime in the near-ish future (don’t ask me when) we could see the advent of brain training programs that do have a significant and lasting impact on cognition.

Until then, there is one thing you can do to have a significant and lasting impact on your brain health… And I’ll tell you in the next post.

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Dr. Julie Robillard is a neuroscientist, neuroethicist and science writer. You can find her blog at scientificchick.com.

Turning Back The Clock Could Mean More Car Accidents: Tips For Better Night Vision

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Our annual “fall back” time change that gives us an extra hour of sleep is welcome news for most of us. But there are some unintended consequences of darker evenings, especially for drivers. According to the National Safety Council, traffic death rates are three times greater at night than during the day.

In a special rebroadcast of the Healthy Vision with Dr. Val Jones show, I interviewed Dr. Christina Schnider, Senior Director, Professional Communications for VISTAKON® Division of Johnson & Johnson Vision Care, about common nighttime driving problems such as dry eyes, headaches, and eye fatigue. I also spoke with John Ulczycki, Group Vice President – Strategic Initiatives, for the National Safety Council, about safe driving tips. You can listen to the show here:

Most people experience a drop in visual acuity in the dark, and this can cause difficulty seeing traffic signs, pedestrians and roadside objects. The primary reason why it’s difficult to see at night is that our pupils dilate to let in as much light as possible. The trade off with large pupils is that visual acuity suffers. It’s normal for the average person’s visual acuity to drop from 20/20 to 20/40 in low light conditions.

Because of vision challenges, driving in low-light conditions can fatigue the eyes and head and neck muscles as the driver strains to see the environment more clearly. Dry eyes can occur from reduced blink rates and motor vehicle heating and cooling systems. Glasses wearers may have a reduced field of vision which further complicates driving in the dark. In fact, in a recent survey one -in-three drivers reported that they didn’t see well at night.

Dr. Schnider and Mr. Ulczycki suggest that night time driving may be safer (and more comfortable) with these tips:

1.  Update your eyeglass or contact lens prescription(s). Since darkness reduces visual acuity, wearing lenses that correct your vision to 20/20 in normal light conditions is extra important. Old glasses or contacts with outdated vision correction power can make driving in the dark more hazardous. If you experience significant challenges seeing at night, you may have a condition called “nighttime myopia” and should visit your eye doctor for advice.

2. Avoid driving long distances in low-light conditions. Since we already know that driving in the dark can cause eye fatigue, dry eyes, and reduced visual acuity, it’s best to minimize the time you spend behind the wheel during dark hours. Whenever possible, plan your travel so that the majority of your driving time occurs during daylight hours.

3. Take frequent breaks. Even though it’s tempting to push through your fatigue and finish driving those last miles to your destination, it’s safer to give yourself (and your eyes) a break. Stopping for gas or at a rest area may improve your alertness and visual fatigue. Remember that impaired drivers are more likely to be on the road at night, so vigilance on your part may prevent an accident.

4. Decrease your night-time driving speed. If you do need to drive in the dark, doing so more slowly may prevent accidents. Traveling at a slower speed can improve reaction time under lower-visibility conditions.

5. Check your headlights. It is estimated that 50% of all motor vehicle headlights are not optimally aligned. Potholes and bumps in the road can jolt the lights out of alignment. It’s important not to look directly at oncoming headlights. This can temporarily blind you as your pupils adjust to a quick change in lighting conditions.

For more safety tips, please listen to the full Healthy Vision podcast.

*Val Jones, M.D. is a paid consultant for Johnson & Johnson Vision Care, Inc.*

Another Fake Cancer Cure: Ukrain

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Edzard Ernst, M.D., Ph.D.

Cancer patients are understandably desperate to try every treatment that promises a cure. They often turn to the Internet where they find thousands of “alternative” cancer cures being sold often for exorbitant cost. One of them is Ukrain.

Ukrain is based on two natural substances: alkaloids from the Greater Celandine and Thiotepa. It was developed by Dr Wassil Nowicky who allegedly cured his brother’s testicular cancer with his invention. Despite its high cost of about £50 per injection, Ukrain has become popular in the UK and elsewhere.

Ukrain has its name from the fact that the brothers Nowicky originate from the Ukraine, where also much of the research on this drug was conducted. When I say much, I should stress that I use this word in relative terms. In the realm of “alternative” cancer cures, we often find no clinical studies at all. For Ukrain, however, the situation is refreshingly different; there are a number of trials, and the question is, what do they really tell us?

In 2005, we decided to review all the clinical studies which had tested the efficacy of Ukrain. Somewhat to our surprise, we found 7 randomised clinical trials. Even more surprising, we thought, was the fact that all of them reported baffling cure rates. So, were we excited to have identified a cure for even the most incurable cancers? The short answer to this question is NO.

All of the trials were methodologically weak; but, as this is not uncommon in the area of alternative medicine, it did not irritate us all that much. Far more remarkable was the fact that these studies seemed to be odd in several other ways.

Their results seemed too good to be true; all but one trial came from the Ukraine where research governance might have been less than adequate. The authors of the studies seemed to overlap and often included Nowicky himself. They were published in only two different journals of little impact. The only non-Ukrainian trial came from Germany and was not much better: its lead author happened to be the editor of the journal where it was published; more importantly, the paper lacked crucial methodological details, which rendered the findings difficult to interpret, and the trial had a tiny sample size.

Collectively, these circumstances were enough for us to be very cautious. Consequently, we stated that “numerous caveats prevent a positive conclusion”.

Despite our caution, this article became much cited, and cancer centres around the world began to wonder whether they should take Ukrain more seriously; many integrative cancer clinics even started using the drug in their clinical routine. Dr Nowicky, who meanwhile had established his base in Vienna from where he marketed his drug, must have been delighted.

Soon, numerous websites sprang up praising Ukrain: “It is the first medicament in the world that accumulates in the cores of cancer cells very quickly after administration and kills only cancer cells while leaving healthy cells undamaged. Its inventor and patent holder Dr Wassil Nowicky was nominated for the Nobel Prize for this medicament in 2005…”  .

Somehow, I doubt this thing with the Nobel Prize. What I do not question for a minute, however, is this press release by the Austrian police: since January, the Viennese police have been investigating Dr Nowicky. During a “major raid” on 4 September 2012, he and his accomplices were arrested under the suspicion of commercial fraud. Nowicky was accused of illegally producing and selling the unlicensed drug Ukrain. The financial damage was estimated to be in the region of 5 million Euros.

I fear, however, that the damage done on desperate cancer patients across the world might be much greater. Generally speaking, “alternative” cancer cures are not just a menace, they are a contradiction in terms: there is no such a thing and there will never be one. If tomorrow this or that alternative remedy shows some promise as a cancer cure, it will be investigated by mainstream oncology with some urgency; and if the findings turn out to be positive, the eventual result would be a new cancer treatment. To assume that oncologists might ignore a promising treatment simply because it originates from the realm of alternative medicine is idiotic and supposes that oncologists are mean bastards who do not care about their patients – and this, of course, is an accusation which one might rather direct towards the irresponsible purveyors of “alternative” cancer cures.

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Dr. Ernst is a PM&R specialist and the author of 48 books and more than 1000 articles in the peer-reviewed medical literature. His most recent book, Trick or Treatment? Alternative Medicine on Trial is available from amazon. He blogs regularly at EdzardErnst.com and contributes occasionally to this blog.

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